Provider Demographics
NPI:1457335234
Name:MAYUGBA, JEMELLE JUNE (MD)
Entity type:Individual
Prefix:DR
First Name:JEMELLE
Middle Name:JUNE
Last Name:MAYUGBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2900 N MILITARY TRL
Mailing Address - Street 2:SUITE 245
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6365
Mailing Address - Country:US
Mailing Address - Phone:561-994-2007
Mailing Address - Fax:561-208-1281
Practice Address - Street 1:9453 AEGEAN DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-6684
Practice Address - Country:US
Practice Address - Phone:561-951-3517
Practice Address - Fax:561-208-1281
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBM8431366207RH0002X
FLME88349207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002107200Medicaid
H95421Medicare UPIN
FL81124VMedicare PIN